Using community health workers in San Francisco for preterm birth prevention

Summary: 
Community health workers (CHWs) are an underutilized and uniquely equipped workforce to reduce longstanding disparities in preterm birth (PTB) across the U.S. The personal and public burdens of PTB are well documented, with a disproportionate share of the burden falling to families in poverty and minority communities, and social and psychological stressors play important roles.

Principal Investigators:
Melanie Thomas, MD, MS | Psychiatry | UCSF School of Medicine
Laura Gottlieb, MD, MPH | Family and Community Medicine | UCSF School of Medicine 


Objectives

The objectives of this study were twofold: 1. To determine feasibility and acceptability of using CHWs to conduct psychosocial screening and linkage to existing services for at-risk pregnant women. 2.

Introduction

Community health workers (CHWs) are an underutilized and uniquely equipped workforce to reduce longstanding disparities in preterm birth (PTB) across the U.S. The personal and public burdens of PTB are well documented, with a disproportionate share of the burden falling to families in poverty and minority communities, and social and psychological stressors play important roles.

Method

To examine the effectiveness of CHW outreach in a high-risk pregnant population. The study population included patients in the safety net hospital of San Francisco county with CHWs from a nearby community-based organization. The first twelve months were devoted to training of CHWs, establishing work flow with prenatal care providers and staff, developing a Wellness Orientation to support services and assessing initial feasibility and satisfaction with interventions (Aim 1). The second twelve months of the study period were devoted to tracking the CHW intervention (Aim 2). Study participants were recruited using direct approach by CHWs in the clinic. Data collection included qualitative interviews with staff and chart review.

Results

Clinic staff reported an overwhelmingly positive response to the inclusion of CHWs in the clinic workflow, citing enhanced relationships with patients and a crucial link to services. The CHWs connected to 40 patients in the hospital, the majority of whom were managing trauma histories and homelessness. Eighty percent of the patients followed up to receive direct services at the community organization, including language-concordant groups, classes, case management, and concrete resources such as strollers, car seats, food, and diapers. However, in the postpartum period, forty-five percent of patients were lost of follow up.

While the majority of individuals were successfully linked to supportive services through the CHW intervention, robust follow-up services in the postpartum period are needed.

Project team: 

Melanie Thomas, MD, MS

Assistant Professor
Psychiatry

Laura Gottlieb, MD

Associate Professor
Family Community Medicine

Laura Gottlieb, MD, MPH, is a Professor of Family and Community Medicine at UCSF. A former National Health Services Scholar and safety-net family physician with fellowship training in social determinants of health, Dr. Gottlieb now serves as Principal Investigator on multiple quantitative and qualitative projects examining the integration of social and medical care services.